Cat Scratch Disease: 9 Years of Experience at a Pediatric Center

Abstract

Background A more complete understanding of the epidemiology, risk factors, and clinical features of cat scratch disease (CSD) in children could help guide patient care. Methods We conducted a retrospective analysis of children presenting to a tertiary pediatric hospital system in Atlanta, Georgia between January 1, 2010, and December 31, 2018 who had serology, PCR and/or cytopathological results consistent with a Bartonella henselae infection. We also retrospectively reviewed veterinary diagnostic results performed at the University of Georgia (UGA) from 2018-2020 to ascertain the burden of bartonellosis in companion animals within the state. Results We identified 304 children with CSD over 9 years with the largest proportion of diagnoses made during August (41/304, 13.5%) and September (47/304, 15.5%). The median age of child cases was 8.1 years (interquartile range (IQR) 5.4-12.1]; 156 (51.3%) were female; 242/262 (92.4%) reported feline exposure, while 55/250 (22%) reported canine exposure of those with exposure histories documented in the medical record. Although lymphadenopathy was present on physical examination in the majority of cases (78.8%), atypical presentations lacking lymphadenopathy were also common (63/304, 20.7%). Among children with radiographic imaging, 20/55 (36.4%) had splenomegaly and 21/55 (38.1%) had splenic and/or hepatic microabscesses. Among veterinary data, Bartonella seroprevalence was 12/146 (8.2%), all among canines, with a geographic distribution that spanned the state of Georgia. Conclusion Distinguishing clinical features of CSD included subacute regional lymphadenopathy in school-aged children in the late summer, almost all of whom had cat exposure. Atypical clinical manifestations of CSD were also commonly identified.

Atypical Cat Scratch Disease With Splenic Lesion Mimicking Kawasaki Disease in a Healthy 5-Year-old Girl

“…In serological tests, serum B. henselae IgM and IgG sensitivities are low at 63.2% and 95.5%, respectively. 4,5 It has also been reported that among the 61 patients who underwent serologic testing and showed serological evidence of B. henselae infection, 75% of the initial serological tests yielded negative results for B. henselae IgM titers. 6 In the analysis of biopsies using Warthin-Starry silver staining in the 12 patients with histopathologically confirmed CSD, B. henselae was detected in the lymph nodes in the early stage of lymphadenopathy but not in the granulomatous stage.…”

“…[1][2][3] Diagnosis is often challenging because of the low sensitivity of serological tests and the difficulty in detecting characteristic lesions by physical examinations and imaging investigations. 2,[4][5][6] As spontaneous resolution of the disease is expected in immunocompetent patients, the clinical benefit of antimicrobial agents and other therapies remains unclear.…”